Provider Demographics
NPI:1417905613
Name:GREATER LANSING SURGEONS, P.C.
Entity Type:Organization
Organization Name:GREATER LANSING SURGEONS, P.C.
Other - Org Name:GREATER LANSING SURGEONS, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-487-8255
Mailing Address - Street 1:2815 S PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3496
Mailing Address - Country:US
Mailing Address - Phone:517-487-8255
Mailing Address - Fax:517-487-2059
Practice Address - Street 1:2815 S PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3496
Practice Address - Country:US
Practice Address - Phone:517-487-8255
Practice Address - Fax:517-487-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICM005070208600000X
MISS013541208600000X
MIJD014681208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICA 3383OtherRAILROAD MEDICARE
MI4404799Medicaid
MI5330326OtherBCBSM
MI53311215OtherBCBSM
MI4748047Medicaid
MI5331175OtherBCBSM
MI5330326OtherBCBSM
MI5331175OtherBCBSM
MI53311215OtherBCBSM